FEMA-EC950310 (2)ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAMA'FrENTION: Use of this certificate does not provide a waiver of the flood insurattce purchase requirement. This form is used only toprovideelevationinformationnecessarytoensure'compliance with applicable community floodplain management on:linanses, todeterminetheproperinsurancepremiumrate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).'Instructions for completing this form can be found on the following Pal es.
SEC¥iON A PROPERTY INFORMATION r-oh ~ ¢_-c~__=N~y us;
BUILDING OWNER'S NAME
STREET ADDRESS (Incl~,-,t) Apt.. Umt, Suite am~/o~ Bldg. Numbeq OR P.O. ROUTE AND 8OX NUMSER
OTHER DE~RIPT~ (~ ~ B~ Nu~. e~.)
SECtiON B FLeD ~SURANCE RATE ~ (RRM) ~FOR~ON
ProvUe ~ fol~wing from the ~o~r FIRM (~ I~tru~ns):
POl. Jcy NUMBER
COMPANy NNC NI. JM~.R
ZIP CODE
7. Indicate the elevation datum system used on the FIRM for Rase Flood Elevatione (BFE): ~GVD '29 [] Other (describe on back)8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: I J I J I I. UJ feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top. of the reference level floor from the selected diagram is at an elevation
w~of I J 15 Io [3 I. ~ feet NGVD (or other FIRM datum-.~ee Sec~n B, item 7).
b). FIRM Zones Vl-V30, YE, and V (with BFE). The.t~ottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of I *l~ J I I I.[_..J leer NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A (without BFE). The floor use~ as the reference level from the selected diagram is I ! I.~.J feet above [] or
below [] (check one) the highest grade edjacen, t to the
d). FIRM Zone AO. The floor used as the relerence*levetfrom the.se[ected diagram is I I I.LJ feet above [] or below [] (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the buiiding's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? [] Yes J'-'] No [] Unknown
Indicate the elevation datum system used in determi~i_ng the above reference level elevations: [] NGVD '29 [] Other (describe3. under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than'that used on
the FIRM [see Section B, Item 7], then converl the eievat~ns to the datum system used on the FIRM and show ti~ conversion
equation under Comments on Page 2.) ......
4. Elevation reference mark used appears on FIRM: [] Yes [~'No (See Instructions on Page 4)
5. The reference level elevation is based on: ,~ actual constructio~ :' [] construction drawings
NOTE: Use of construction drawings is only valid if tl~e ~b,~u.~Tdipg ~ not yet have the reference level floor in place, in which
case this certificate will only be valid for the buil~i~g'~jU~ir~ ~tie ~ of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adiacent to the buildinG is:J J ] J ] J.L_J feet NGVD
CERTIFIER S NAME . ~.', .
TITLE
e: /